The Largest Health Disparity We Don’t Talk About

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half‑century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

We may assume that people with mental health problems die of “unnatural causes” like suicide, overdoses and accidents, but they’re much more likely to die of the same things as everyone else: cancer, heart disease, stroke, diabetes and respiratory problems. Those with serious mental illness are more likely to struggle with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Nearly half don’t receive treatment, and for those who do, there’s often a long delay. When these patients do make it into our clinics and hospitals, it’s clear that we could do better. A troubled mind can distract doctors from an ailing heart or a budding cancer.

“With the right kind of care, people with serious mental illness can integrate back into society,” said Dr. Dawn Velligan, professor at UT Health San Antonio and a director at the clinic. “They can have regular jobs, relatively normal lives. We just need to intervene before things get unmanageable.”

Early results are promising: Historically, about 7 percent of psychiatric patients return to the hospital within a month, but only 1 percent of those seen in the transitional clinic do. Despite the program’s success, inconsistent funding has limited the number of patients the clinic can reach — a reflection of how society continues to undervalue mental health.

“When there’s a commitment to these patients, there’s a lot we can do,” Dr. Velligan said. “But right now, they’re not a priority. People have to want to care for them. We have to care.”

After decades of fragmenting medicine into specialties and subspecialties, it’s perhaps not surprising that a siloed system often fails those in need of whole‑person care.